March 05, 2006

Schizophrenia - Prevention and Early Interventions

There is a good article covering the latest research into the prevention of schizophrenia and early interventions that might lessen the severity of the illness - in the February issue of Psychiatric Times (a news source for psychiatrists).

The story notes:

It was not too long ago that the management of schizophrenia was generally viewed as pessimistic, and focused primarily on symptom relief. Over the past two decades, there has been a paradigm shift in our approach to the overall management of schizophrenia, toward preventive and early interventions. These approaches are being increasingly guided by recent pathophysiological models. In particular, it has become clear that neurobiological alterations are seen before onset of the illness (the premorbid phase) and may progress during the early stages of the illness (the prodromal phase).

Further deterioration in brain structure and function may appear in some cases after characteristic symptoms of the illness begin (the psychotic phase), especially during the initial years. These observations suggest a critical window of opportunity, early in the illness, to effect lasting modifications in overall illness course.

The three key questions for the field are:

1. Can schizophrenia be prevented in those at risk for the disorder (primary prevention)?

2. Can the first episode of psychosis be prevented in patients experiencing the prodromal phase of the illness (secondary prevention)?

3. Can we prevent relapses and further functional decline in patients who have already experienced the first episode of psychosis (tertiary prevention)?

Recent work, outlined below, suggests that considerable progress has been achieved in these areas over the years.